2,000 years of Chinese acupuncture
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2,000 years of Chinese acupuncture In China today most medical practitioners have some training in biomedical and traditional medicine. Varying degrees of integration are evident institutionally in the delivery of health- care at hospitals, in diagnosis, explanatory models of disease, therapeutic paths, and drug preparations. Some indigenous traditions, such as pharmacotherapy, acupuncture and moxibustion or massage are on offer in modern hospital and clinical settings, and even on emergency wards. Far from being subsumed under the high tide of a globally powerful biomedicine, according to WHO estimates in 2002, traditional medicine still accounts for about 40% of Chinese health care. Indeed a multi-million pound trade in prepared Chinese medicines world-wide testifies to a two-way transfer of knowledge and techniques. With mass emigration and the globalisation of a plurality of medical traditions, Chinese medicine now survives in many different forms, transforming as it comes into contact with different cultures around the world.
Transcript of 2,000 years of Chinese acupuncture
2,000yearsofChineseacupuncture
InChinatodaymostmedicalpractitionershavesometraininginbiomedicalandtraditionalmedicine.Varyingdegreesofintegrationareevidentinstitutionallyinthedeliveryofhealth-careathospitals,indiagnosis,explanatorymodelsofdisease,therapeuticpaths,anddrugpreparations.Someindigenoustraditions,suchaspharmacotherapy,acupunctureandmoxibustionormassageareonofferinmodernhospitalandclinicalsettings,andevenonemergencywards.
Farfrombeingsubsumedunderthehightideofagloballypowerfulbiomedicine,accordingtoWHOestimatesin2002,traditionalmedicinestillaccountsforabout40%ofChinesehealthcare.Indeedamulti-millionpoundtradeinpreparedChinesemedicinesworld-widetestifiestoatwo-waytransferofknowledgeandtechniques.Withmassemigrationandtheglobalisationofapluralityofmedicaltraditions,Chinesemedicinenowsurvivesinmanydifferentforms,transformingasitcomesintocontactwithdifferentculturesaroundtheworld.
ChineseHealthCare
HealthcareinChinaembracesawidevarietyofdifferenttraditions.Fromwellbeforethebeginningofimperialhistory(221BCE),therearenaturalistictheoriesofhealthanddiseasebaseduponideasaboutman’srelationshipwiththeheavensandearth,theweather,andthepassingoftheseasons.Equally,forthemostpartofthepasttwothousandyearsChinesescholarlymedicaltraditionshaveregardedthehumanbodyasvulnerabletointerferencebyancestors,demonsandspirits.
ClassicalChinesephysiology,baseduponideasaboutman’srelationshipwiththespirits,withtheheavensandearth,theweather,andthepassingoftheseasonsiswell-documentedfromthelateWarringStatesperiod(c600-221BCE).Thiswasatimewhenphilosophersandgentlemenhawkedtheirskillsaroundthecourtsofthekings.Thefirstemperorwasparticularlyfondoffangshi(gentlemenofremedies)who,itissaid,transmittedtheartsofZouYan.LittleisknownaboutZouYanexceptthathis‘school’waspurportedtobetheinstitutionaloriginoftheYinandYangphilosophies.Indocumentsofstategeneratedbytheseadvisers,intheirmilitarytactics,divination,medicalandreligiousmatters,wefindtheearliestrecordsofYinYangandthewuxing(fiveagents).
EarliestcorrespondenceswithYinandYang
TheYinandYangsystemofcorrespondencebecametheenduringorganizingprincipleoftheepistemologicalframeworkbehindmanyChinesetraditions.
Table1setsouttheearliestcorrespondenceswithYinandYang.Basedinlargepartonobservationsofchangeinthenaturalenvironment,theywereasimplemappingtoolfororderingtimeandspace,usedindivination,medicine,orasaguidetomilitaryaction.Individualpairschangeaccordingtotimeandcontext.
TheEarliestCorrespondenceswithYinYang
Yang YinHeaven EarthSpring AutumnSummer WinterDay NightBigStates SmallStatesImportantState UnimportantStatesAction InactionStretching ContractingRuler MinisterAbove BelowMan WomanFather ChildElderBrother YoungerBrotherOlder YoungerNoble BaseGettingonintheworld BeingstuckwhereoneisTakingawife/begettingachild MourningControllingothers BeingcontrolledbyothersGuest HostSoldiers LabourersSpeech SilenceGiving Receiving
YinandYanginmedicine
IntimemedicaltheoristsadaptedtheYinandYangcorrespondencestointerpretsignsandsymptomsofillnessspecificallyformedicalintervention.
Yang YinOuter InnerUpper LowerDorsal VentralQi氣 Xue血(Blood)Vitalfunction MaterialSubstrateStimulation RestraintIncrease,Growth Decrease,DeclineAscent DescentOutwardOrientation InwardOrientation
ThisrepresentationofYin-yangdatingtoca11thcenturymodelschangebyrepresentingtheopposingbutcomplementaryforcesofYinandYang.Eachflowsinto,andcontainstheseedof,theother.
DivinationinHealthCare
AsaschemeforinterpretingthechangingnatureoftheworldtheYinYangsystemfollowsinthewakeoftheYiJing(ClassicofChanges),agreatrepositoryofwisdomthattookshapeinthefirstmillenniumBCE.ThesymbolsusedinYiJingdivinationarethe‘8trigrams’,whichwhencombinedmake‘64hexagrams’,eachonethenrelatedtoacrypticstatementinthetext.Traditionallytherelevanthexagramisidentifiedbythrowingyarrowstalks,butinmoderntimesdivinerstendtousecoins.Thedivinerthenbringsthehexagramsalivethroughinterpretingthecypticstatementaccordingtothetopicofconcerntothequestioner,whetherthatbetodecidewhentogotowar,whentomarryortoforetelltheoutcomeofanillness.
SomeoftheearliestwritingsinChinawereinscribeduponturtleshellsandcowscapulas.TheyaretherecordsofdivinersinthecourtsoftheShangdynastykings(trad.Dates1766–1122BCE).Someoftherecordsrelatetothekingsillnesses.
TheWuxing(fiveagents)correspondences
TheFiveAgentscorrespondencesexpandedthecorrelationalbasisforinterpretingexternalphenomenonwithgroupsoffive.Xing,meaningliterally‘togo’isoftentranslated‘element’,butthisdoesnotdojusticetothedynamicqualitiesimpliedbytheterm.Ratherthaninertsubstancestheyareconstantlytransformingforcesthatpowertheworld.Fromtheirearliestincarnationsasaschemetointerprettheriseandfallofdynasties,theyultimatelygavebroaderdefinitiontotherelationshipbetweentheexternalworldandthehumanbodywithgroupsoffive:fiveseasonsoftheyear,fiveflavours,fiveorgansetc.Inpracticephysicianschosetoemphasisedifferentsetsofcorrespondencesatdifferenttimes,buttheeverevolvingsystemsofcorrespondenceshapedanenduringsciencefoundedonmetaphysicalthought.
WuXingcorrespondencesaccordingtoTheAnnalsofLuBuwei(239BCE)
Wood Fire Earth Metal Water8 7 5 9 6Spring Summer LateSummer Autumn WinterEast South Centre West NorthSour Bitter Sweet Acrid SaltyGoatish Burning Fragrant Rank RottenJupiter Mars Saturn Venus MercuryWind Heat Thunder Cold RainWheat Beans Pannicled
MilletHemp Millet
Liver Heart Spleen Lungs KidneyEyes Tongue Mouth Nose EarsAnger Joy Desire Sorrow FearShouting Laughing Singing Wailing GroaningBlue-green Red Yellow White BlackScaly Feathered Naked Furred Shelled
TheMianyangfigurine
Thisfigurineexcavatedfromamilitaryofficer’stombinSichuan,WestChina,anddatingtoca118BCE,istheearliestimageofthebodycontouredbylines.Itdoesnotmarkacupuncturelociandnolociarementionedinrecordsthatdatebeforethistime.Wecanonlybecertainthatitwasamapofthebodyconsideredimportantenoughtobeplacedintheoutercoffincompartmentofthetomb.Asthelinesclusterandmeetaroundthesenseorgans,theymustrelatetheirauthor’sideasaboutvision,hearing,sight,tasteandtouch,andarethereforelikelytorepresentpartofthehumanstructurethatboundsandmediatesbetweentheinternalandexternalworlds.Isthisthenasensorymapofthebody,ratherthanamodelconcernedwithillness–theearsandeyesofitsdeceasedowner?
EarlyToolsandPractices
Acupunctureandmoxibustionarisefromasynthesisofoldermedicalpracticessuchaspettysurgery,massage,bloodletting,hotstonetreatment,andexorcisticarcherywithnewideasaboutthenatureoftheuniversethatflourishedinthelateWarringStates.AlthoughsharpstoneandboneneedlesandknivessurvivefromNeolithictimes,acupunctureandmoxibustionwerefirstlinkedtogetherwithatheoryofthechannelsinHantimes(206BCE–220CE),althoughtheaccountsdescribeproceduresquiteunlikethetreatmentsthatweknowtoday.
EarlyChinesestonesthatmayhavebeenusedformassagingthechannels.
MappingtheBody
Theearliestversionsofthechannelsillustrateaspectsofskeletal,muscularandarteriovenousstructures.Theyalsomapasensoryexperienceofthebody:ofpain,pleasureandpassion.AtthesametimetheearlytextsmatchtheacupuncturechannelsandthemovementofqiinthebodytotheriversofChinaandtothecyclesoftheheavenlybodies.
AreconstructionofasilkchartfromtheMawangduitomb(closed168BCE)showingtherapeuticexercisesfromtheWesternHanperiod.
SelfCultivationandChineseMedicine
Ideasaboutthemovementofthespiritsandsouls,aswellasqiinthebodydevelopedasscholarswroteaboutlongevitypracticessuchassexualandbreathtechniques.Intakingtheinnerrealmofthebodyasitsfocusforimprovement,self-cultivationculturegeneratedclassicalChineseconceptsofphysiologicalprocesswherebythegrossmaterialofthebodycouldbeinvigoratedandrejuvenated.
Manyofthesetraditionssurviveaspartofanever-changingfundoffolkmedicalknowledge:elderlypeoplegatherintheparkstopracticeTaijiquan,theslow,gentlemartialartthatmovesqiandstrengthensthespirit.Theypassonassumptionsaboutdietarycareandtonicmedicines.
AreconstructionofasilkchartfromtheMawangduitomb(closed168BCE)showingtherapeuticexercisesfromtheWesternHanperiod.
BianQueandMrWhite
IntraditionalhistoriestheoriginsofacupunctureoftenrelatetothelegendofBianQue,acultfigureassociatedwithahumanheadedbird.Hisname,togetherwiththeYellowEmperorandthemysteriousBaiShi,“MrWhite”,islistedinthetitlesofmedicalliteratureintheofficialhistoryoftheWesternHandynasty(202BCE–23CE).NothingisknownaboutMrWhite,butabiographyofBianQue,attributingtohimsupernaturalpowers,isinShiJi(RecordsoftheGrandHistorian,comp.104-87BCE),InthisEasternHan(25-220CE)stonereliefBianQue,inthecentre,isgivingatreatmenttoawomanpatient.
TheYellowEmperor
TheYellowEmperorwasoneofthemythologicalculturebringers.Chargedwithcivilisingasavageworld:hemodelledpunishments,lawandthecalendarafterdivinepatternsthoughttobeimmanentinHeavenandEarth.Hehadaroleindivinationanddividingtheseasons–anditistheseskillsthatlinkedhimwithessentialmedicalarts–aknowledgeofthebody’srelationshipwiththecyclesandphasesofnatureandtheaccuratepredictionoftheprogressofdisease.ItishisnamethatwefindlendingauthoritytothemostcomprehensivecollectionofearlyChinesemedicaltexts,theYellowEmperor’sInnerCanon.Herewecanfindthebodydividedintotwelvedistinct‘channels’throughwhichqi(theall-pervasivestuffthatpowerstheuniverse),wasthoughttomoverhythmicallyaroundthebody.ThechannelssurfacedintheformofthepulseatplaceswhereancientChinesephysicianscouldexaminetheconditionofthebody’sqi,andtheorgansthroughwhichitflowed.Alargenumberofpulsetypesweredistinguished,suchasfloating,superficial,sunken,hesitant,andthisbecamethepre-eminentmethodofdiagnosisforelitephysicians.
Background:ImagesofPulseQualitiesMojueShanghaiMedicalUniversity
Moxibustion
Moxibustion,aformofheattreatment,wasoneoftheearliestandmostimportantmethodsfortreatingthechannels.Beingmoreaccessibleandcheaperthanneedlesitwasamorepopularandwidespreadtreatment.Thedriedandgroundleavesofmugwort(artemesiavulgaris)burntonandoverthebodyarefirstknowninatropaictechniquesusedtoprotectthehouseholdfromattackbydemons.Chinesemedicalpractitionersnowadayswillburnitontheendofmetalneedles,usecigar-shapedrollsofmoxibustion,orrollconestostimulateparticularpointsorpainfulpartsofthebody.
ASongdynastypaintingdepictingacountrydoctorperformingtreatmentonapatient’sback.ImagecourtesyoftheNeedhamResearchInstitute.
TheEarliestSurvivingMoxibustionCharts
AmongthethousandsofBuddhistmanuscriptsdiscoveredacenturyagoinahiddencavelibraryatDunhuangontheSilkRoadweresome100medicalmanuscripts.Onedamagedseriesofsketchesofthebody,nowheldintheBritishLibrary,givessimpleinstructionsforthetreatmentofspecificconditionswithmoxibustion.Thefiguresconstitutetheearliestsurvivingmoxibustionchartsandpre-datetheNorthernSongacupuncturebronzesthatlayoutcomprehensivenetworksofacupunctureloci,bysomethreeorfourcenturies.CharacteristicoftheDunhuangarchiveisthatitpreservesaverywidevarietyoftechnicalmanuscriptsinwhichwefindintimateglimpsesofpopularmedicaltheoryandpracticeinTangdynasty(618–907CE)ChinaatthisNorthwesternoutpostoftheempire.
BritishLibraryOr.8210/S.6168
InnerAlchemy
ClassicalChineseperceptionsofthemedicalbodymirroredthegeographical,philosophical,politicalandreligiousrealitiesofearlyChina.Thesurfaceofthebodywaslandscapedwithmountainrangesandwaterways,anditsparkledwithrepresentationsofthesunandmoon,starsandconstellationsinthenamesofanatomicalandacupuncturelocations.Patternsandhierarchiesofimperialbureaucracyandadministrationstructuredtheimaginationofphysiologicalprocess.
InmediaevaltimesChinese‘inneralchemy’oftenassociatedwiththeShangqing(SupremePurity)schoolofDaoism,wasonecontextwithinwhichlyricalimageoftheinnerbodyflourished.Precededbytheolderpracticeofcompoundingofelixirsfrommetalsandminerals,‘InnerAlchemy’aimstoproduceanelixirthroughpracticesthatrefinethesubstanceswithintheadept’sbody.
NineNeedles
ClassicsofChineseacupuncturetendtoexpressdissatisfactionwiththecrudemethodsassociatedwithearlyacupuncture.Yetmuchofthetherapydescribedinoneearlytreatiseknownas‘NineNeedles’describespettysurgery,blood-lettingandmassage.Needlesformovingqiwereofrarequality,likenedto‘finehair’.
AMing(1368–1644CE)reconstructionoftheNineNeedles
TheSong(960–1279CE)Bronzes
ImperialpatronageofacupunctureflourishedintheTangperiodandwasonthecurriculumoftheSongImperialMedicalCollege.InSongtimesscholarssoughttosystemisemedicalknowledge.BronzeacupuncturefigurineswerefirstcastbyWangWeiyi(11thcentury)forthepurposesofteachingandexamination.Theyclearlydisplaythecirculationnetworksandlabeleachacupuncturepoint.Whenthemodelwascoveredwithalayerofyellowwaxandfilledwithwater,medicalstudentshadtolocatetherequiredacupointexactlywithaneedle,causingwatertogushoutofthemodelthroughthehole.
Abronzefigurinemadetoimperialdecreein1727CEPhoto:WellcomeMedicalMuseum
AfifteenthcenturyinterpretationofWangWeiyi’sbronzesBeijingNationalMuseumofHistory
MedicalPlurality
Survivingdocumentaryevidenceofacupuncturetheoryrecordstheworkofascholarlymedicalelite.ButthroughoutChinesemedicalhistorywefindtracesofmorepopularpractice.Mingnovels,forexample,describelargegroupsofcompetingandcomplementarypractitioners.Acupunctureemergesasalowerclassofpractice,lessprestigiousthantheprescriptionofChinesemedicaldrugs,andoftentheworkofwomen.InJapansomeofthemostrespectedpractitionersofacupuncturearetobefoundintheblindcommunity.
‘Belldoctors’wereitineratephysicianswhocalledattentiontotheirpresencebyringingabell.WellcomeLibrary
AcupunctureinLateImperialChina(1368–1911)
DuringtheMingandQingdynastiestheimportanceofacupuncturedeclinedrapidly.PhysicianslikeZhangJiebin(1563-1640)andXuDachun(1693-1771)notedthattherewerefewwell-knownacupuncturiststobefoundintheirtime.In1822theImperialAcademyprohibitedtheteachingandpracticeofacupuncture.Thereasonsforthisdeclineincludedadislikeofneedlesamongpatients,theemergenceofgentlertherapiessuchastuinamassage,andthepreferenceofelitephysiciansforherbalmedicine.Acupuncturewasamanualtherapyunsuitedforthescholar-physiciansthatdominatedthefieldofmedicine.Itbecameaspecialistdisciplineoftenpractisedbyexternalmedicinephysiciansasapartofalargerrepertoireofpettysurgerytechniques.
ThephotoshowstheacupuncturetoolsofYuJinghe(1847-1907),aphysicianfromChangshuinJiangsuProvince.
TheModernisationofChineseMedicineinRepublicanChina(1911–1949)
Fromthelatenineteenthcenturyonward,physiciansofChinesemedicineincreasinglyadvocatedtheneedtomodernizetheirtraditionifitwastosurviveinarapidlychangingsociety.ThisincludedtheestablishmentofWestern-styleschools,collegesandhospitals,thefoundingofprofessionalassociations,andthepublicationoflearnedjournals.Duringthisperiod,traditionalmedicinealsohadtodefenditselfagainsteffortsbymoreradicalmodernizerstodisbanditspracticealtogether.
In1929,amotionintendedtoprohibitthepracticeoftraditionalmedicinewasputbeforeparliament.Inresponse,physiciansoftraditionalmedicineunitedforthefirsttimeintheirhistoryintoonesinglegroupataconferenceheldinShanghaion17March1929.TheconferencesentadelegationtothecapitalNanjingthatsuccessfullylobbiedtohavethemotiondeferred.TheeventsofMarch1929arethereforeseenasthebirthofmodern“traditional”ChinesemedicineandMarch17thisstillcelebratedinTaiwanandSingaporeas“NationalMedicineDay.”
TheNewChinaChineseMedicineCollegeinShanghaiandthe1929DelegationtoNanjing.
TheDevelopmentofChineseMedicineinContemporaryChina(1949–)
ChineseCommunistleadershadlongviewedChinesemedicineasa“feudalsuperstition.”However,asMaoZedongbegantodistancehimselffromtheSovietUnionhechangedhismind.Mao’sChinesecommunismfocusedon“patriotism,”on“beingselfreliant”and“native”andChinesemedicinefittedthisbill.From1954onwarditwasusedasasymbolforChina’sculturalgenius.CollegesofChineseMedicinewereopenedinShanghai,Guangzhou,ChengduandBeijingin1956,andin1958Chinesemedicinewasdeclaredanationaltreasurebythegovernment.ButChinesemedicinewasnotlefttoitsowndevices.Itwasexpectedtomodernise,scientise,andeventuallyintegratewithWesternmedicine.Inthe1980s,itwasdefinedbylawasbeingpartofapluralhealthcaresysteminChinaanditsinfrastructuredevelopedfurther.Sincethe1990s,theChinesegovernmenthasmadeeffortstoglobaliseChinesemedicineandtodevelopitseconomicpotential.
CalligraphybyMaoZedong“Chinesemedicineisagreattreasurehouseandshouldbediligentlyexploredandimprovedupon.”
ModernAcupuncture
Poverty,lackofpublichealthcareandageneralspiritofrenewalstimulatedsomedoctorsinRepublicanChinatopromoteacupunctureasacheapalternativetodrugbasedmedicine.OneofthemwasChengDan’an(1899-1957),anacupuncturistandpaediatricianfromJiangsu,whohadvisitedJapanintheearly1930s.OnhisreturntoChinain1933,heopenedthefirstmodernacupuncturecollegeinChinainWuxi.Hisacupuncturewasbasedonclassicaltheorybutattemptedtosystematizeitinordertomeettheneedsofamodernaudience.Throughhisstudents,hiswritings,andhispoliticalactivityChengDan’anexertedaprofoundinfluenceonthedevelopmentofacupunctureinChina.AtthesametimethatChenDan’anwasdevelopinghisacupunctureinChina,JapaneseacupunctureinJapanalsowitnessedarevival,whereacupuncturistslikeYanagiyaandSawadadeveloped“meridiantherapy”.Althoughpromotedunderthebanner“returntotheclassics”,it,too,wasadistinctlymoderninnovation.ThroughitsdiffusionintoTaiwan,GermanyandFranceitinfluencedthedevelopmentofacupunctureintheWest.
Oldacupuncturecharts
